Comparing the Effect of Painless Labor Methods on the Duration of Active Phase of Labor

Authors

1 Obstetrics and Gynecology Department, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran

2 Students’ Research Committee, Baqiyatallah University of Medical Sciences, Tehran, IR Iran

10.17795/rijm30834

Abstract

Abstract Background: Applying an appropriate method of analgesia in labor without alteration in its progression is of high importance. Previous literature did not provide much information about the effect of various kinds of anesthesia on the duration of active phase of labor. Objectives: To assess the effect of painless labor methods on the duration of active phase of labor. Patients and methods: 80 pregnant women referring to Najmieh hospital in 2013, with tendency to painless labor, were randomly selected for this analytical cross-sectional study using simple random sampling technique. After taking history and physical examination, cases were under observation of an obstetrician. After achieving a 4 cm cervical dilation, cases underwent analgesia by epidural, spinal or general anesthesia. Applying analgesia to complete dilation and complete dilatation to fetus delivery, time intervals were recorded by an obstetrician. Results: Studied individuals had a mean age of 25.95 years. Type of applied analgesia for painless labor was epidural in 6 (7.5%) nulliparous cases, spinal in 58 (72.5%) cases and general anesthesia was applied in 16 (20%) individuals. There was no significant difference for analgesia to complete dilation time interval between analgesia methods (P ˃ 0.05). Also, there was no significant difference between applied analgesia methods for complete dilation to fetus delivery time interval (P ˃ 0.05). While, analgesia to fetus delivery time interval was significantly lower in general anesthesia method rather than epidural method (P = 0.034). Conclusions: We found that analgesia-assisted labor shortens active phase and prolongs second stage of labor, it does not increase the risk of cesarean section as well.

Keywords


  1. 1.Danforth DN, Gibbs RS. Danforth's obstetrics and gynecology. Philadelphia: Lippincott Williams & Wilkins; 2008.

    1. Indraccolo U, Ripanelli A, Di Iorio R, Indraccolo SR. Effect of epidural analgesia on labor times and mode of delivery: a prospective study. Clin Exp Obstet Gynecol. 2012;39(3):310–3. [PubMed: 23157031]
    2. Zhang J, Yancey MK, Klebanoff MA, Schwarz J, Schweitzer D. Does epidural analgesia prolong labor and increase risk of cesarean delivery? A natural experiment. Am J Obstet Gynecol. 2001;185(1):128–34. doi: 10.1067/mob.2001.113874. [PubMed: 11483916]
    3. Nguyen US, Rothman KJ, Demissie S, Jackson DJ, Lang JM, Ecker JL. Epidural analgesia and risks of cesarean and operative vaginal deliveries in nulliparous and multiparous women. Matern Child Health J. 2010;14(5):705–12. doi: 10.1007/s10995-009-0515-9. [PubMed: 19760498]
    4. Alexander J. Epidural analgesia lengthens the friedman active phase of labor. Obstetr Gynecol. 2002;100(1):46–50. doi: 10.1016/ s0029-7844(02)02009-4.
    5. Adams SS, Eberhard-Gran M, Eskild A. Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery. BJOG. 2012;119(10):1238–46. doi: 10.1111/j.1471- 0528.2012.03433.x. [PubMed: 22734617]
    6. Simmons SW, Taghizadeh N, Dennis AT, Hughes D, Cyna AM. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev. 2012;10:CD003401. doi: 10.1002/14651858. CD003401.pub3. [PubMed: 23076897]
    7. Sng BL, Leong WL, Zeng Y, Siddiqui FJ, Assam PN, Lim Y, et al. Early versus late initiation of epidural analgesia for labour. Cochrane Database Syst Rev. 2014;10:CD007238. doi: 10.1002/14651858. CD007238.pub2. [PubMed: 25300169]
    8. Hasegawa J, Farina A, Turchi G, Hasegawa Y, Zanello M, Baroncini S. Effects of epidural analgesia on labor length, instrumental delivery, and neonatal short-term outcome. J Anesth. 2013;27(1):43–7. doi: 10.1007/s00540-012-1480-9. [PubMed: 22965331]
    9. Anim-Somuah M, Smyth R, Howell C. Epidural versus nonepidural or no analgesia in labour. Cochrane Database Syst Rev. 2005;(4):CD000331. doi: 10.1002/14651858.CD000331.pub2. [PubMed: 16235275]
    10. Feng N, Ni Z, Feng-Lian W. Influence of the labor analgesia to delivery outcome in the different period of birth process. Matern Child Health Care China. 2012;32:025.
    11. Cheng YW, Shaffer BL, Nicholson JM, Caughey AB. Second stage of labor and epidural use: a larger effect than previously suggested. Obstet Gynecol. 2014;123(3):527–35. doi: 10.1097/ AOG.0000000000000134. [PubMed: 24499753]
    12. Agrawal D, Makhija B, Arora M, Haritwal A, Gurha P. The effect of epidural analgesia on labour, mode of delivery and neonatal outcome in nullipara of India, 2011-2014. J Clin Diagn Res. 2014;8(10):OC03–6. doi: 10.7860/JCDR/2014/9974.4930. [PubMed: 25478409]
    13. Alexander JM, Lucas MJ, Ramin SM, McIntire DD, Leveno KJ. The course of labor with and without epidural analgesia. Am J Obstetr Gynecol. 1998;178(3):516–20.
    14. Miller RD, Pardo M. Basics of anesthesia. Elsevier Health Sciences; 2011.